Start with an emergency physician

See all

Zhou Yuan took another look at the marked area and said,"Use the great saphenous vein graft for bridging, then reconstruct the arteriovenous fistula outflow tract, and finally remove the thrombus.

" The great saphenous vein is the superficial fascia under the skin.

It is very long, extending from the front of the medial malleolus to the thigh, and it has the inherent advantages of being suitable for transplantation: the lumen is of appropriate thickness, and the length can be flexibly controlled.

If it is to be long, it is long enough, and if it is to be short, it can be cut.

Moreover, the acquisition method is very simple. Just cut the skin and you can find it under the skin. In addition, there are few side branches, so fewer blood vessels need to be processed during transplantation.

"Is it really possible……"Several vascular surgery doctors were very hesitant.

He Jianyi glanced at Zhou Yuan, who nodded.

""Okay, let him do it." He Jianyi said.

Seeing He Jianyi nod, the vascular surgery doctors didn't say much.

"Although vascular transplantation is only a third-level operation,... considering the patient's current physical condition, the operation is very risky."

Zhou Yuan stepped forward, looked at He Jianguo's pupils, and said:"The operation must be performed immediately. I will be responsible if there is any problem!"

He Jianyi said:"I will be responsible. What responsibility do you, an intern, have!"

At this point, He Jianyi was stunned again.

Dean Fang told him this morning that he might give Zhou Yuan an exceptional promotion recently.

Originally, Dean Fang planned to promote Zhou Yuan's professional title after completing the finger regeneration operation.

However, if someone sees that Zhou Yuan is just an intern when writing a paper, I am afraid they will not even read the title and directly reject the paper.

Moreover, if it really appeared in The Lancet, the doctor who could write in The Lancet was actually just a small intern in Yanjing International Hospital... This would make the medical community think that Yanjing International Hospital does not value talents, etc.

In any case, Zhou Yuan's intern hat must be removed, at least to shut up some people.

""Hurry up and do the surgery! The old man can't hold on any longer!" Zhang Ling was a little anxious.

The heart rate and blood pressure were already a little unstable. If the blood vessels were not transplanted and the blood clots were not cleared as soon as possible, He Jianguo would be in danger.

He Jianyi became serious:"Hurry up and push him to the operating room!"

He Jianguo's son and daughter quickly made way, while Zhou Yuan and others held the handles and pushed the operating table into the operating room quickly.

In the operating room.

Under the shadowless lamp, He Jianguo was already unconscious.

Zhou Yuan and others gave simple first aid, stabilized the heart rate and blood pressure, and then started anesthesia.

The operation used epidural block anesthesia.

He Jianguo lay on the bed in a supine position, and the right limb to be operated on was spread out on the operating bed.

"Anesthesia is complete!" The anesthesiologist said quickly.

Zhou Yuan nodded, glanced at the time, and said,"The operation begins."

The personnel for this operation.

Chief surgeon: Zhou Yuan

First assistant: He Jianyi

Second assistant: a vascular surgeon

Third assistant: a vascular surgeon

Instrument nurse, anesthesiologist, etc.

""Scalpel." Zhou Yuan said.

The first step is to separate the basilic vein in the upper arm and the cephalic vein near the elbow, and estimate the length of the blood vessel to be transplanted.

Zhou Yuan skillfully cut open the skin, then separated the subcutaneous tissue, muscle tissue, etc., found the basilic vein, and measured the length of the blood vessel to be transplanted.

"49.01mm" Zhou Yuan said.

The second step is to separate the great saphenous vein, and then cut blood vessels from the great saphenous vein for vascular transplantation.

Zhou Yuan put down the scalpel.

He Jianyi and a vascular surgeon have already disinfected the lower abdomen, condyle and thighs of both lower limbs.

""Spread the towel."

He Jianyi exposed the femoral artery, and Zhou Yuan cut down the inside of the femoral artery with his knife, making a longitudinal incision about six centimeters long.

"Separate the great saphenous vein." Zhou Yuan said

""

After making the incision on the inner side of the femoral artery, Zhou Yuan cut the skin and subcutaneous tissue at this point, and cut the superficial fascia at the femoral artery incision to expose the oval fossa.

After finding the oval fossa, it is not difficult to find the great saphenous vein. The confluence of the great saphenous vein and the femoral vein is here, and it is easy to see the great saphenous vein.

"Curved hemostatic forceps.

Zhou Yuan used the curved hemostatic forceps to separate the main trunk of the great saphenous vein.

"Cut off the branches of the great saphenous vein.

This step is very important.

If there is a mistake or the blood vessel ruptures, it will be impossible to suture or bleed during the vascular transplantation, which is fatal.

"Vascular clamp."

Block the blood vessels, Zhou Yuan began to separate along the venous trunk of the great saphenous vein.

The great saphenous vein has branches such as the superficial iliac circumflex vein, superficial abdominal wall vein, superficial external iliac vein, lateral abdominal vein and medial femoral vein. After finding these branches and ligating and cutting them one by one, the branches of the great saphenous vein are cut.

"Start cutting the great saphenous vein segment."

Zhou Yuan picked up the scalpel and began to peel off the great saphenous vein whose branches had been cut off.

"Wait... why did you just peel it off?"He Jianyi and the vascular surgeon were both stunned.

Generally speaking, peeling off a blood vessel requires clearing away all the connective tissue outside and separating the blood vessels individually.

But Zhou Yuan just did it directly. He wanted to cut off all the blood vessels and the tissues attached to them.……

"Wait, you used the No-touch technique?"The second vascular surgeon was a little surprised.

"No-touch technique?"

"Yes, it is a technology proposed by Country M, but it is not widely used... Moreover, it is quite difficult because it requires precise cutting of tissues and blood vessels, which can damage other tissues and blood vessels if you are not careful... This is more difficult than simply stripping blood vessels!"

He Jian was stunned for a moment, he had some impression

"This... seems to reduce the incidence of vascular stenosis?" He Jianyi said uncertainly

"51.40mm has been cut off." Zhou Yuan removed a section of blood vessels connected to connective tissue and said

"It is indeed a No-touch technique, used to cut the great saphenous vein, which can greatly reduce the incidence of vascular stenosis and improve the success rate of vascular transplantation."Zhou Yuan explained.

The blood vessels in Zhou Yuan's hand are like the mutton on the kebab, but the color is brighter and it is in strips.

"Wait, why did you cut 20mm more?" asked the young and inexperienced vascular surgeon.

Zhou Yuan tested the separated great saphenous vein and explained,"You have never been exposed to this technology, so you don’t understand. The great saphenous vein will shrink after being taken out of the body, so it is best to make it 2~4cm longer than the expected length.""

"Heparin saline."Zhou Yuan said.

The next step is to inject heparin saline into the great saphenous vein.

This is to test whether this section of the great saphenous vein has infiltrated.

After injecting the heparin saline into the blood vessel, Zhou Yuan carefully ligated the great saphenous vein and carefully examined it.

——

I recommend a friend's book"Tang Dynasty: The Salted Fish Son-in-law", which is super exciting, you can go and have a look! _To read the ununderlined version of the novel, please download Flylu Novel AP